Driver Privacy Protection Act

Drivers Privacy Protection Act Misuse Complaint

First Name*

Last Name*

Email Address*

Street Address*

Address Line 2*

City*

State*

ZIP Code*

Phone*

Describe the nature of your concern.*

Explain your concerns briefly, listing the events in the order in which they occurred, and desribe why you feel that your personal information has been compromised or released to unauthorized parties. Click the Select Files button below to provide copies of notices, or any other documentation you have related to your concern. Please include names of any entities involved.

Attach (Maximum total size: 2MB)

Drop files here or

Accepted file types: gif, jpg, png, pdf, doc, docx, xls, xlsx.

Please answer the following questions; your answers will assist us in investigating this matter:

1. Have you recently visited a driver license/tax collector office (online or in person) to conduct business related to your driver license or a motor vehicle, boat or mobile home? This may be a new issuance, renewal, replacement, address change, title transfer, etc.*

3. Have you, or any member of your household, recently made any changes to your automobile insurance?*

No

Yes

If yes, provide a description of the change and the date it was made below.

4. Have you recently visited a dealership, automotive repair shop or had your oil or tires changed on your vehicle?*

No

Yes

If yes, please provide the business name, address, date of transaction and type of transaction below.

5. Have you recently been involved in a motor vehicle crash?*

No

Yes

If yes, please provide the date of the crash.

Please note: The Department of Highway Safety and Motor Vehicles automatically blocks personal information in all motor vehicle and driver license records maintained by the department. Pursuant to Section 119.0712(2),F.S., personal information in motor vehicle and driver license records are protected and are only released to parties authorized to receive personal information pursuant to DPPA as outline in 18 United States Code, section 2721.

I certify the information provided is accurate/true and by typing my name in the box below and checking the authorize box, authorize the Department of Highway Safety and Motor Vehicles to release my name to entities that have obtained my personal information in order to conduct an inquiry.*